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0 0 <br /> 4reffrr PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please)Q PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: \�(ri1; t-�0'A1- 'w. `.V,V 6j . \\IT'` PROPERTY TAX#: ),) t-fr 770 ;7V 2 i7C) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:-..Jef f-y- ,.1 60, \,ie_ Lj-�e)1,A)(,ty-A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET' Li 5 1 )-ZV4S IM r O(f, I , N <br /> SI. 1 reA,i fr\c___ CITY STATE VV II/67- ZIP l 42 33 <br /> OWNER PHONE:2-0(o - 3 a -c. 6 4+0 OWNER EMAIL: G.q 11 is` — Y1.(74-WO , GO WI <br /> CONTRACTOR NAME: ") O\tl\t <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: MOWNER I kONTRACTOR MOTHER(Please Specify) Mi4/ A Ur"�)r,- ' 71-33, - 5Oc <br /> CONTACT NAME: CONTACT PHONE: <br /> � 2ato -ID - �Io4D <br /> \`t ei &7?,,W 1'iA CONTACT EMAIL: GA`I l .io \— 7 im,5 ' ` cowl <br /> BUILDING PERMIT APPLICATION ( -------' <br /> Existing Use of Building: Contract Price of Work:$ J D 1 1 4 IC) <br /> Proposed Use of Building: Heat Source: [as I lklectric ether _ <br /> Building Type: �I FR-Detached I;iFR-Attached )uplex ilulti-Family-#of Units: [ ,ommercial LIndustrial <br /> Type of Project:..Jew Lddition IThkemodel IThkepair BE .1. Li i n Ik prinkler Lemolition I`-lhhange of Use <br /> DESCRIPTION OF WORK: �`a' <br /> (� N�� I te�v'�'yv�, �(2 7 s-F. ��- o U-e,v' A 4er4 ��r =t= ���� r e.,. <br /> AAA 2-coo -. j�V-r'r" . -Tthe-jvAsS A (o'L �i.F.. A-GG-� avvek A <br /> l,v,'(! U Sv ;^,clvd.✓(2� VvGtvi \ bt.ioL'I �r 04,- 1 l�i.),-- r ',-1 <br /> f � �5 GtY1-Gt ��)'�Gt'rW�^�. �'�DO� �h G�R'f:� C'�v�t�C�C:�t'�`-����, <br /> ` v 11 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,�V`. - .�L r." r , ,, ,.1 ,�A�, \ . ,A,-.1'VCCitv\ I n, :.1 6(cf <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: >(New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> A/C-Air Handling Units I Heat Pump Z. Toilet '-----1-/'N--£Pask(IN-Pre�e r si e Bldg) <br /> 1 Forced Air Systems Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler 2 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater Refrigeration Z Shower to <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range I Ducting I Dishwasher zi Roof Drains <br /> 1 Clothes Dryer Hookups Other: I Clothes Washer Medical Gas _ <br /> I Range Hood fk�(ate.s.Heate� _ Other: <br /> —4- Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> 'Number of Heads <br /> ACKNOWLEDGEMENT.'I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes'approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> •1 e\ City of Everett Official Use Only <br /> PERMIT# <br /> 1 77 \11 C P-0 c — 00 1 <br /> Owner/Authorized Agent nature v — Dat (Revised 9/23/2016) ` <br /> ll— <br />